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HomeMy WebLinkAbout030-1094-10-150 L oT 3 030-logq- 10-12,6 1 30 - L STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER o,JA4e) f ~o~~ ~ffoE.~/~/F5 ADDRESS_ S/9fJ C, PZ a tOSoA / 4J, SYy/~, SUBDIVISION / CSM#_C'S14 Vol, /V - /0s}GE a14/17 LOT SECTION SW T 3a N-R 19 W, Town of ''57 JoSe.AW ST. CROIX COUNTY, WISCONSIN Sys, KOV0 rn ~-o 7,7 PLAN VIER SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM S/~ StN Sao SEtrEr (/Nf /000 aAt t„)iftf CavefETE S,-Ave Tiwc wiTr/ M,+AjhWE WE4~ A A-Q T6,4-r A44G dN ~<ESNGwr~rusO£crfnN AOE IPE~/DEticf /G.S i OeoP /Rex SET To l1/EQf~cq~ QPo~ cgLAA441e 0.5,4019ctTF AT 014-11,'. • G fFLI /,E•Vr Tu /g ,TIq ~r"" a1x ENO ~T CGrrthG E Ae rcc V~wJTS ~ i J S EgST ~vo~PjY ~i E. yo' QE~u«IMMPK- E[EV. /v~.oo' TP , sTEr~ P.oF S~ouTN ~l~epF/l~/,iv~ INDICATE NORTH ARROW' Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. BENCHMARK: ~fJ Or STEF[. AAE EV "00 ,00, A"0,6 ALTERNATE BM: AIA . Ili SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: ~icJE15E/r Liquid Capacity: /Obb Setback from: Well Gs~ House "S Other Pump: Manufacturer Model# Size Float seperation Gallons/cycle: Alarm Location q SOIL ABSORPTION SYSTEM Width: Length Number of trenches Distance & Direction to nearest prop. line: S®u-rH Setback from well: House 3S' Other T" ELEVATIONS Building Sewer ST Inlet. /o11/.3S' ST outlet PC inlet PC bottom Pump Off Header/Manifold Bottom of system A-95?, co, cry.©a' Existing-Grade A "Final grade f~. /oa. jo' Q /O/. /O/.So r DATE OF INSTALLATION: ~p PLUMBER ON JOB: i IJPoS.~~~ LICENSE NUMBER: 335'S INSPECTOR: 3/93:jt wisconlin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor and Human Relations INSPECTION REPORT ST. CROIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION Permit Holder's Name: ❑ City ❑ Village Town of: State PIAW9Q THOENNES, RONALD AND LORI 1 St. CT Parcel Tax No.: CST BM Elev.: Insp. BM Elev.: BM Description: /t~e) ' /d6), 60, 7/ A9590903 / TANK INFORMATION ELEVATION DATA 5/ Z TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 0~ /jam, Cb' Dosin L~ 0.35 /D~ 71 Aeration Bldg. Sewer 1473/ 4 Holdin St/ W Inlet 3z/ /p5/ 74/ i TANK SETBACK INFORMATION St/ Outlet ' I'd Vent TANK TO P/ L WELL BLDG. AirIto ntake ROAD Dt Inlet Air Septic ~SU /5-/- NA Dt Bottom Dosing NA Header~rm._ x.03 Aeration NA Dist. Pipe 9, 99 y 7 Holding Bot. System ~z, ,cam PUMP/ SIPHON INFORMATION Final Grade Manufac rer Deman 19 9 o sI . , D 75zl'll Model Number GPM TDH Friction stemFt Forcemain Length TDiaLK Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH width Length No. Of Trenches pl No. Of Pits Ins* ia. Liquid Dbj4h DIMENSIONS 5d - DI I N SYSTEM TO P / L BLDG WELL LAKE / STREAM LEAC G r. SETBACK INFORMATION TypeO ye C BER ~C Mode Number: System: 7 /,/3 R UNIT DISTRIBUTION SYSTEM - Header / Manifold Distribution Pipe(s) l e Size x Hole Spacin Vent To Air Intak Length Dia. / Length Sam/ Dia. Spacing --L Z SOIL COVER x Pressure Systems Only xx Mound Or At-Grad tems On y Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Trench Center 50 - ~/C ~0E94irench Edges 3C) Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: St. Joseph.32.30.19W, SE, NE, Lot 4, County Road E., _J Cep GF~liraa~L'' r /i!~r7~ c'~^f? e .a Ls c-.~ ~rr"'~ - x07 v Plan revision required? ❑ Yes L'1 No / Use other side for additional information. L-5d SBD-6710 (R 05/91) Date Inspector's Signatur Cert. No. ADDITIONAL COMMENTS AND SKETCH ` SANITARY PERMIT NUMBER: =MR SANITARY PERMIT APPLICATION DIn accord with ILHR 83.05, Wis. Adm. Code COY T ~A_~ STATE SNI_T gE T iv -Attach complete plans (to the county copy only) for the system, on paper not less than o(p( 01 8% x 11 inches in size. ❑ Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER / PROPERTY LOCATION d Na<o e n I / /T(JEN.vES 5E t/4 NE %4, S 3.? T ~o, N, R /`7 E (or)9) PROPERTY OWNER'S MAILING ADDRESS LOT # BLOCK # -/,99 ro o G' CITY STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER ~4405O / w, s v~~ 0/S -s3s c S A%4 vu tP Q!4GF a/ 4 11. TYPE OF BUILDING: (Check one) CITY NEAREST ROAD ❑ State Owned VILLAGE J044--00N co O ZQWN OF: ❑ Public 41 or 2 Fam. Dwelling-# of bedrooms 3 PARCEL TAX UMBER( ) 111. BUILDING USE: (If building type is public, check all that apply) 0. - /v9 u - ~O 1 ❑ Apt/Condo 2 ❑ Assembly Hall 60 Medical Facility/Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/Repairs 11 ❑ Restaurant/Bar/Dining 40 Church/School 80 Mobile Home Park 12 ❑ Service Station/Car Wash 50 Hotel/Motel 9 ❑ Office/Factory 130 Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1 New 2. ❑ Replacement 3. ❑ Replacement of 4.0 Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12, Seepage Trench 220 In-Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Q 9tl SD' A ~LPVAJIION S/S0 5G a . S s ? O - g• o a' Feet 41ol . is5 Feet VII. TANK CAPACITY Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New istin Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank cane /OOb / GJi25E Lift Pump Tank/Siphon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name Print): Plumber's i n lure: No Stamps) MP/MPRSW No.: Business Phone Number: %01,4 &65 339,6 (his 3g~- agso Plumber's Address (Street, City, State, Zip Code): /S -r* Sr A/ ~ Ai4 t0 5 01-J 61" f . IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa tary Pe mi a (Includes Groundwater a e ssue issuing A ent Si tur (N Sta Approved F-1 Owner Given Initial Surcharge Fee) j ~ Adverse Determination X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety 8 Buildings Division, Owner, Plumber r INSTRUCTIONS , 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date; and at the time of renew al any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Farm (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of bedrooms if 1 or 2 Family Dwelling. 111. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending an system type. VI. Absorption system information. Provide all information requested in ##1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than $5% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complefa dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers, water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption ystems,- replacement system areas, and the location of the building served; B) horizontal and vertical elev~rtion reference points; L) complete specifications for pumps and controls; close volume; elevatk.w,~ differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorl lion system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 193'3 Msconsir Act 410 included the creation of surcharges (fees) for a numbs. i o regulated practices which can effect groundwater. Tf ; rre pies collected through there surcharges are used for n-r(.)nitoring grooiidw-i er, gakwr,J- water conta.rnination investigations and establishment of standards. SBD-6398 (R.11/88) ~ ovB/t 3"SO ~7o Nos7N /iz~PlissY LZ.vY /oda 6^L SE?ric 7'fA K PLB 57 \ PLOT & CROSS SECTION PLANS \ y"50~ s5 Pvc E'r~-a«.ur L04DA BROS. EXCAVAtING INC „vE PLUMBING UNIT SS " O^ PROJECT wE,~~ ,~PoP iBo~c SET Tv t0 E 1quA uy D,sTR~BuTS CL '5 £m d 2266, °E'~ L3, Ef~uc~vr -r,) Ew 61-17-H IPES14LVGt" 61-17-H 7E.n1c~~5 ~ ~ G- 5' ST otx uN A, 3y Sc~f yv PVC , /30 ~V,Ew.t-y ~~GE Sc~...E~ 4/,VF r r ~ g r 133 k r r I A :5 171' S<n~~ ~ s~' P~~PE~Y 90, , s<~~f h /NE • A ~s gS' , I a2 yEN'f'S ~T ly BEAk jA Afl( - i oP o F rENCS GENE i 39 NO SCALE FRESH AIR INLET AND OBSERVATION PIPE APPROVED VENT CAP MAXIMUM 12' ABOVE FINAL GRADE 4' CAST IRON VENT PIPE MAXIMUM OF 42' ABOVE I PIPE TO FINAL GRADE I i SIGNED: MARSH MAY OR SYNTHETIC COVERING I I i LICENSE: M Q,PS 4395 MINIMUM 2' AGGREGATE DATE: A -3 ZE 5- OVER PIPE DISTRIBUTION PIPE I TEE SOIL TESTING BY: ELEVATION BED W AGGREGATE • BOTTOM PER SOIL.," BENEATH PIPE PERFORATED PIPE BELOW TEST IS I ! COUPLING TERMINATING A S4 So' FT. AT BOTTOM OF SYSTEM 9 oo' Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Relations `Division of Safety & Buildings in acc0 3.05. Wis. Adm. Code COUNTY Attach complete site plan on paper not less tha j 11 nches in s I must include, but St. roix not limited to vertical and horizontal reference ! BM), and % e, scale or PARCEL I.D. # dimensioned, north arrow, and location and sta' e toed. 030-1094-10 APPLICANT INFORMATION-PLEASE I IT ALL I~lEO~#ibai%N REVIEWED BY DATE PROPERTY OWNER: ;i CF+ iv PQqERTY LOCATION Ronald & Lori Thoennes GIN' Fib LOT SE 1/4 NE 1i4,S 32 T 30 N,R 19 for) W PROPERTY OWNER'-.S MA!i_ING ADDRESS f' . T # BLOCK # SUBD. NAME OR CSM # na. na csm yo18- a e 2147 497 Co. Rd. #E j j_ CITY, STATE ZIP CODE PHO ❑CITY ❑VILLAGE J¢OWN NEAREST ROAD lHudson, WT. 54016 (71rk 549-5357 St. ose h Co. Rd. #E [*New Construction Use (x* Residential / Number of bedrooms 3 (J Addition to existing building [ J Replacement [ J Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd/ft2 - 8 trench, gpd1ft2 Absorption area required 643 bed, ft2 563 trench, ft2 Maximum design loading rate . 7 bed, gpd/ft2 .8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 98.93- 97.15 ft (as referred to site plan benchmark) Additional design / site considerations step down trench system Parent material i-_wach Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem 56 ❑ U ❑ S tau 06 ❑ U IRS ❑ U ❑ S X41 ❑ S MU SOIL DESCRIPTION REPORT i Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-11 10yr3/3 none 1 2msbk mfr gw 2f .5 .6 2 11-22 10yr4/4 none sicl lfsbk mfr gw if .2 .3 Ground 3 22-36 7.5yr4/4 none is Osg myfr 9w na .7 .8 elev. 102.93 _ ft 4 36-96 7.5yr4/6 none co s Osg ml na na .7 .8 Depth to limiting factor +96" Remarks: Boring # 1 0-8 10yr3/3 none sl 2mgr myfr gw if .5 .6 2 2 8-18 10 r4 4 none is Os myfr if .7 .8 3 18-96 10yr4/6 none cos Osg ml na na .7 .8 Ground elev. 102,.93_ ft. Depth to limiting factor +96" Remarks: CST Name:-Please Print Phone: Gary L. Steel 715-246-6200 Address: 1994 9.~~ ond., WT- 94017 Signature: Date: CST Number: Q 5-12-94 c m PROPERTY OWNER R. & L. Thoennes SOIL DESCRIPTION REPORT Page 2 "of~ 3 PARCELI.D.# 030-1094-10 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence I Boundary Roots GPD/ft ) ~ in. Munsell , Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITrendi mfr crw 2f .5 .6 3 2 12-41 10yr4/4 none sic) 2msbk mfr gw if .4 ~.5 Ground 3 41-45 7.5yr4/4 none sl 2mgr mfr gw na .5 1 .6 elev. 1 101.15 it. 4 5-85 10 r4/4 none co s Osg ml na na .7 .8 Depth to limiting factor Remarks: Boring # I 1 0-9 10 r3/3 none 1 2msbk mfr C1w 2f .5 .6 4 " 2 9-24 10yr4/4 none sici lfsbk mfr 9w if .2 .3 Ground 3 24-3 7.5 r4 4 none is Os f .7 .8 elev. 4 36-8 10yr4/6 none co s Osg ml na na .7 .8 95.15 ft. Depth to limiting factor +80" I Remarks: Boring # 1 0-10 10 r3 3 none 1 2m 5s 2 10-1 10yr4/4 none sici lfsbk mfr 9w if .2 .3 Ground 3 16-2 7.5 r4 6 none is Os mvfr Crw if .7 .8 elev. 95.75 ft. - Depth to - limiting factor +80, Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(8.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Ronald & Lori R1 9W es New Richmond, WI 54017 MPRSW 3254 SE4NE4 S32 - T30N-19W (715) 246-6200 town of St. Joseph N 1"=40' BM=top of 1" steel pipe at el. 100' alt. bm= top of steel post at el.78.92 if area of b-1 &2 is cut for walkout seepage bed could be used at el. 98.93 l 4-4- 4 7 5 23 1..i Gary L. Steel 5-12-94 " 451.90 CERTIFIED SURVEY MAP -rum IR W Located in part of the SE 14- of the NE 4 of Section 32, T Town of St. Joseph, St. Croix County, Wisconsin. Q ;;~~c"'t;ps• FILED OWNERS 4% 4~ E 011988. Ronald E Lori Thoennes Michael C Tamera Koenig A. L``t' C. ~ JAMES O'CONNELL 3 Route 2, Box 318N a ~rf3(I' Register Deeds Somerset, WI 54025 t9 SLCroiXCo,,yyl Q CJ~ fill a q~"°,<r' ~G :r NE Corner of °"s~2?~g~~~4a;•.r Section 32 1\1 SCALE IN FEET County Section 200 100 0 200 Monument unplatted land!- owned by others Bearings are referenced to the east line of the NE} of section o 32 assumed to bear NO1°19145"E. North line of the SEI of the NEi;. r1~9hN ? D _ 89 45' 12"W 536.4I'__ A N?go4g 411V 453.89' ItIli, 1W 3 E -99 K 3 N¢ 1 d~~ "7o99, 0_ M 33' 33' r Vol. 563, Pg. 432 ,n sr.48 4.83, small trac ° o IIi9hNa t 1 r N M hL Y R1If 3 /3: { • U rn ( 00' m N P a N89° 14' 25" W a 5' 0~ 2 J N rz' 500.00' 661 Private w Roadway Easement 1~ 111 T ' 3 ~R 2 S i V W 34f 48, $?`4001 00 I/ ` e x -4 i° 'N rn L al 732 97~ rnl dTz Temporary Cul-de-sac y`- ~1 Tb Cul-de-sac to be rernoved if road is 1 ~r n / extended. 01 ~I L 1 3 monumented west line-of C.S.M. l m 1 o in 3 / volume 1, page 96. C;) i N m CL CE) / iTn M I N o o V) W 0) / o I N N /o Z t I _ I n/ V. M Q f` U I 2 / 33 feet on each side and adjacent to the line / between lots 3 E 4 is reserved for road extension if neccessary. 333/ / / w7. ~'t:cV 370.85' M~ 933.71' N890 56' 57" E 1304.56' N South line of the NE} E' Corner of Section 23 C.S.M. vol. 3, pg. 900 111 Iron Pipe This instrument drafted by Fran Bleskacek Proj. No. 88-25 SHEET 1 OF 2 SHEETS VOLUP-IL 3 PAGE' 21117 STC-105 SEPTIC TANK MATNTENANCE AGREEMENT St. Croix County OWNER/BUYER d N PA& N t MAILING ADDRESS 0- AN ~ U U b ~ e PROPERTY ADDRESS L~ Ct ( CUB ec, (location of septic system) se obtain from the Planning Dept. CITY/STATE L~ Q (DS 6v_~ Wt 140 `(zo PROPERTY LOCATION J►~= 1/4, L 1/4, Section T~ N-R~ W WI TOWN OF ST. CROIX COUNTY 4 SUBDIVISION Y-OCULCk , V,00t4"(,; eT,0 I✓ LOT NUMBER CERTIFIED SURVEY MAP << CAO, VOLUME Z) , PAGE-1h I LOT NUMBER Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of roplaceniont of ri failillp, system, which wa;; in opcialiou jwth)i lii lily I, 1079. SI. Croix Comity accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintainer(, The property owner agrees to submit to St. Croix "Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. I/We, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to e St. Croix 'County Zoning Officer within 30 days of the three ear expiration date. SIGNED: DATE: C_ St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property (,L) L L, Location of propertySE /4 t4 1/4, Section 3Z,T 73 ON--R _W -q-~ - Township' Mailing address 67( C~ E E--E , 5 5 y Address of site 4q 2cQ Z- ~~5a LIO Subdivision name t4(_ Lot no. _ Other homes on property? Yes No Previous owner of property Total size of property `(0 CA e-q k6- 5 Total size of parcel ( Q-7 o~ Date parcel was created S O % Are all corners and lot lines identifiable? Yes No Is this property being developed for (spec house)? Yes No Volume-7%2 and Page Number_ as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the ffice of the County Register of Deeds as Document No. 143 of -,s7!5- signature of ~ pplicant o` Applicar7t biz- L ~q jZ- Z~- Date of Signature Date of Signature l>UC:!.l nt t.~ll NO I t"AR`l •1 P'TY CELO ut v.u r,•N a.-uw:, nc o.r. lii .A It \l: 1tG '•1'..;t U'.~f\ l'ttl?"I _ - 19~a jl• ST 't' 1; 431855 ~ ~ P- REGISTER'S OFFICE i ~IOt 196PAGE 51 ! ST. CROIX CO., M ii i i Reed for Record II John A. Cesnik and Jeanne Tierney Nov. 5, 1987 l Cesnik, husband and wife as joint tenants at 8:30 A M ' I >3 and «.•rr:rnt: t~ Ronald N. Thoennes and LorLJ' ftplsterof Deeds Thoennes,.an undivided 112 interest as survivor:~'hip marital. property and Michael J. Koenig and m camera; A. Koenig, an undivided 1/2 interest as survivori,hip marital property (between couples, as tenants in.c<ommQ i and Thomas. L.. Dornfeld and Debra K. VanDelien , as tenants in common between couples and Dornfeld i and VanDellen, title as.terlants in common) the ioll~win„ descril,ed n:,l i,t::te in St. Croix cw;I ty, _ . -I i Tax 1'nrce) No: i SEIC of the NEB of Section 32-30-19 EXCEPT that parcel north of i County Trunk Highway "E", and except that parcel described as: Beginning at a point where the west line of said SE~Z of NEk and the South boundary of County Trunk Highway "E" intersect; thence south along the west line of said SEA of NEk 250 feet; thence east at a right angle 500 feet; thence north parallel with said west line to the said highway; thence westerly along the south boundary thereof to the point of beginning. ~I I I I MNSFER FEE it ~I ~i 'i is not Tkis or•r ta.ul l.. ,h t'.'. (is) (is not) easements, restrictions and rights-of-way of Excrl,tion to x arrantics: record, if any. it it i 3oth October 07 ~I t =John A. Cesnik Jeanne Tierney Cesnik (SEALt j ~i AUTI1ENTICATI0N ACKNOWLEDGMENT Signature (s) St . Croix authenticated this dac or.. I f, r lulc hr'r•Ir ule8 is 3.0 ..dap of I October ,r the above n.an,ed - - John A. Cesnik, Jeanne Tierney TITLE: N[E.IBER STATE BAIL O Cesnik (If not . ! authorized by $ 06.00, %Vis. Sl:tt~.) „ t I n t„ tin. ro^-~n S who cxccuteci the :ul,t .r~:~ioylcJcc ti:e,._amc. Tti S INSTRUMENT WAS OPAFCFO F1Y Kristina Ogland Lundeen Alia " t~ttorney at Law ce J. rletSALWear ':t Croix "o, ~Pwi j (Sienat rp: may he ❑^thontica _d r nc':n • i 1. C - ~a~@ are not r.cress:.rp.) June 11, 1~ 89 i i • Vemea -f Dereocr ( t.. - . 1, %kA1tRA.%TY CF:-.j - co ICA FILED ~o D E OCT051995► 5 3 4 R 9~s eNo"r p ssH 11 OCT 1 3 19% 6~hr . Croix Co., WI ST. CROIX COUNTY OR'S RECORD CERTIFIED SURVEY-ate Located in part of the SEJ of the NEJ of Section 32, T30N, R19W, Town of St. Joseph, St. Croix County, Wisconsin; including Lot 4 and part of Lot " 3 of Certified Survey Map recorded in Volume 8, Page 2147 at the St. Croix County Register of Deeds Office. N d O. L - yn N 4.) _T O 4) 0) Nhr- . 0 o NE Corner c a Section 32 0 Li L. c. w 0A 66' PRIVATE ~ ROADWAY EASEMENT-e` 9 W o~i o v / ~s ~C7T rT Ln m 4. wc~ 8 G Ln L. .o M N7604 LL7 z a01 Ali 66.481 9 41,,W 31 M w m o I 3g <Wftt 30 C~ vN r "OORP H ~o,. S30,16, 766.711 > C7 1.5 a trHf 99. e LOT 5 _s Fttrre Orsy3 169.071 (ti 67 4.00 Acres SOurm OF P j 'v z 174,245 Sq. Ft. rgoP 1~,.. M o~- M f f 3 LOT 6 ,;...~.._--••N r ~ °3 3.95 Acres rfjl y 171,897 Sq. Ft. 0 (Jr Q ~'f O ~1~.•~~• N ~ ^ r W `i n)! h 2 M 3/ cn n Z m ~ 3 ro M~R 80 r tD• R 141 S7M° Q,~ _ N77 °0g 12211 N 4- o SS4, W o z 233.00 Of nF Un 505.931 o ° s8y~°~° o LOT 8 to _j 9 3.66 Acres 309 A; w R 159,353 Sq. Ft. z (~I 6' .O v °03 h DUSE 6 ci c• T 6 7 600%` , 0 :r GARAGE r' N 655.08' t' U~1 3r '751 w % 570.08' 1018.71' x4• 363.63 Ek, Corner v.. oin N89°56157"E 1084.710 Section .32 L M South line of the NEk, ST • CROlx COMr-l o n L01 I C.S. M. `✓C) • 3, PG. 900 CornWoh nsire his :j - - - - - - - - - - Zonis aid ci f LEGEND Parks Comm'08 % Al tl uminum County Section Corner Monument Found hI ~ $ 3q:L • 1" Iron Pipe Found i if not recorded O 1 x 2411 Iron Pipe Set, weighing 1.6*3tbk.30 +fays o1 r ~z per linear foot approval data ~ , EN 1 X Existing Fencel i ne -)pproval shah be- YHA OWNERS w P vnid $L' Mid ael J. & Tamara A. Koenig y " ~l 'DSGi`I, ~1:-4 Oornfel d .......u 1rViS. CODebra K. VanDellen Ronald N. & Lori J . Thoennes % 497 Cty. Rd. "E" Hudson WI 54016 90&0W 44 SCALE IN FEET 1" - 200' W 100 50 0 100 200 300 0 SHEET 'l of 2 SHEETS +r VOL. 11 PAGE 3000 N